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Surgical Closure of the Patent Ductus Arteriosus in Premature Infants by Axillary Minithoracotomy (액와 소개흉술에 의한 미숙아 동맥관 개존증의 외과적 치료)

  • Cho, Jung-Soo;Yoon, Yong-Han;Kim, Joung-Taek;Kim, Kwang-Ho;Hong, Yung-Jin;Jun, Yong-Hoon;Shinn, Helen Ki;Baek, Wan-Ki
    • Journal of Chest Surgery
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    • v.40 no.12
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    • pp.837-842
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    • 2007
  • Background: Closure of the ductus arteriosus is often delayed in premature infants, which creates a hemodynamically significant left to right shunt that exerts an adverse effect on the normal development and growth of these babies. We reviewed out experience on surgical closure of patent ductus arteriosus via axillary minithoracotomy in premature infants. Material and Method: From April 2002 to October 2006, 20 premature infants whose gestation was under 37 weeks underwent surgical closure of patent ductus arteriosus as a result of complications or contra-indications for the use of indomethacin. Their mean gestational age was 28.8+3.4 weeks, ranging from 25+3 to 34+6 weeks, and the average age at operation was $15.6{\pm}6.3$ days. The mean body weight at operation was $1,174{\pm}416\;g$, ranging from 680 to 2,100g; 16 infants were under 1,500 and 9 infants were under 1,000 g. The procedures were performed in the newborn intensive care unit via $2{\sim}3\;cm$ long axillary minithoracotomy with the infant in the lateral position with left arm abduction. The mean size of the patent ductus arteriosus was $3.8{\pm}0.3\;mm$. For the most part, the ductus was closed with clips; 2 infants in whom the ductus was ruptured while dissection was being performed underwent ductal division. Result: Ten of twelve infants who had been ventilator dependent preoperatively could be successfully weaned from the ventilator at a mean duration of 9.7 days after the operation. There was no procedure-related complication or death. Two infants eventually died of the conditions not related to the operation; one from sepsis at postoperative 131 days and the other from pneumonia at postoperative 41 days, respectively. Conclusion: Surgical closure of the patent ductus arteriosus improved the hemodynamic instability and so promoted the successful growth and normal development of premature infants. Considering the low surgical risk along with the reduced invasiveness, early and aggressive surgical intervention is highly recommended.

Narrative Inquiry : Practical experience of an Introduction to Engineering (공학입문 교과 실행경험에 관한 내러티브 탐구)

  • Park, Kyung-Moon;Kim, Taehoon
    • 대한공업교육학회지
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    • v.34 no.2
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    • pp.128-160
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    • 2009
  • Narratively I have described interactions between two teachers performing an introduction to the engineering class with various situations such as place, teacher, student and subject. I have specifically illuminated a three-dimensional narrative inquiry space embracing the culture of the university, the college of engineering and the ABEEK(Accreditation Board of Engineering Education of Korea)program. The result of the study is as follows: First, in order to stimulate the students' motivation, the teachers have to make not only their class PowerPoint slides match the size of the classroom, but the content of the slides must be condensed with core concepts. They also should utilized some video clips to empower students' interest in the subject within their classrooms. Second, the teachers should do various class activities in the classroom. Instead of spending most of the class time with his/her explanation, it would be advantageous for the teachers to allow the students to perform a task in class. Third, the teachers should ask their students about assignments which are helping students' understanding of the subject and planning of their future. Lastly, the teachers need to design the mid-term and the final tests inducing the students' motivation. Those tests also must test students' creativity and insight of the subject. Thus, the test should consist of an interpretive exercise and an essay type of item thus reducing the multiple choice types of items. There are several limitations to the study. First it is difficult to generalize what we found here because it is a case study. Second, we could not study in depth the effect of the interaction between the two teachers who were performing the introduction to the engineering course during the academic semester. Third, this study just probed into the difficulties of teaching the course. Hence, we have to understand more by focusing on each issue such as adapting to a new learning environment as a student from abroad, a practical experience boosting the students' interest in the introduction to the engineering course, also a practical experience on process based learning-versus result based learning, and an effective management of the student team presentation etc.

Long Term Outcome of Endoscopically Clipping the Upper Part of R4 Sympathetic Block and R4 Sympathetic Block for the Treatment of Palmar Hyperhidrosis (수장부 다한증에서 Clipping에 의한 흉부4번 교감신경절 상부 차단술과 흉부4번 교감신경절 완전 차단술에 대한 장기성적 비교)

  • Choi, Bong-Chun;Kim, Yong-Han;Sa, Young-Jo;Park, Jae-Kil;Lee, Sun-Hee;Sim, Sung-Bo
    • Journal of Chest Surgery
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    • v.40 no.11
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    • pp.752-758
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    • 2007
  • Background: Thoracic sympathetic block surgery is a safe and effective procedure for palmar hyperhydrosis, and this maintains sufficient moisture and prevents compensatory hyperhidrosis. To avoid compensatory hyperhidrosis, the authors performed sympathetic block surgery just above the R4 level to maintain sympathetic tone affecting the caudal area. Material and Method: A total of 71 subjects (45 males and 26 females) were categorized into two groups. Group 1 (31 patients, mean age: 25.5 years) had clips placed both on the upper and lower part of R4 sympathetic ganglion, and group 2 (40 patients, mean age: 25.9 years) underwent clipping of the upper part of R4. Telephone surveys were done to collect data on 8 categories, and the average follow up interval was 24.9 months (group 1) and 18.9 months (group 2). Result: For group 1, 41.9% experienced no sweating and 48.4% re-plied they experienced some sweating depending on the surrounding conditions. Group 2 showed that 60% experienced no sweating and 35% replied they experienced some sweating depending on the surrounding conditions, 58.1% in group 1 experienced sweating right after the surgery, and 40.0% in group 2 experienced the same. Group 1 (38.1%) and group 2 (37.5%) replied they experienced no hand dryness and more patients in group 2 than in group 1 had hand dryness, but without uncomfortable symptoms. 71.0% (group 1) and 62.5% (group 2) replied they had no compensatory hyperhidrosis or related symptoms. One patient in group 1 and two in group 2 reported they regretted undergoing the procedure. The regions of compensatory hyperhidrosis were the back, thigh and chest in group 1 and the group 2 reported the back, chest, and abdomen in the order of frequency. Fewer incidences of the gustatory hyperhidrosis were noted in group 2. Most of the patients were satisfied with their treatment. Conclusion: Clipping the upper part of the R4 ganglion or R4 sympathetic block are both effective for treating palmar hyperhidrosis and these treatments decrease the occurrence or symptoms of compensatory hyperhidrosis. The upper R4 sympathetic block procedure is easier and safer with fewer incidences of gustatory hyperhidrosis and a higher percentage of patient satisfaction.

Development and Effects of Instruction Model for Using Digital Textbook in Elementary Science Classes (초등 과학 수업에서 디지털 교과서 활용 수업모형 개발 및 효과)

  • Song, Jin-Yeo;Son, Jun-Ho;Jeong, Ji-Hyun;Kim, Jong-Hee
    • Journal of the Korean Society of Earth Science Education
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    • v.10 no.3
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    • pp.262-277
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    • 2017
  • Digital textbooks enable learning that is appropriate to the characteristics and level of learners through various interactions. The purpose of this study was to develop an instruction model that can more effectively use digital textbooks in elementary science classes and to verify its effectiveness. The results were as follows. The instruction model for helping learners complete their learning by using digital textbooks needs to receive diagnostic assessment and feedback on entry behavior, to build a self-directed learning environment, and to interact with teachers, students, and digital textbooks as scaffolding. In this study, we developed an instruction model using digital textbooks reflecting these characteristic. The instructional model consists of preparation, practice and solidity step. In the preparation step, the learner performs a diagnostic evaluation using digital textbooks. Based on the results, feedback provided at each level can complement the entry behavior and maintain interest in learning activities. In the practice step, self-directed learning is implemented using diverse functions of digital textbooks and various types of data. In the solidity step, learners can internalize the learning contents by reviewing video clips which are provided by teachers, performing problem-solving activities, and accessing outcomes accumulated by learners in the community online. In order to verify the effectiveness of this model, we selected the "Weather and our Life" unit. This experiment was conducted using 101 students in the 5th grade in B Elementary School in Gwangju Metropolitan City. In the experimental group, 50 students learned using a smart device that embodies digital textbooks applied with the instruction model. In the comparative group, 51 students were taught using the paper textbooks. The results were as follows. First, there was a significant effect on the improvement of the learning achievement in the experimental group with low academic ability compared with the comparative group with low academic ability. Second, there was a significant effect on self-directed learning attitude in the experimental group. Third, in the experimental group, the number of interactions with the learner, teacher, and digital textbook was higher than the comparative group. In conclusion, the digital textbooks based on the instruction model in elementary science classes developed in this study helped to improve learners' learning achievement and self-directed learning attitudes.

Dorsal Mini-thoracotomy for PDA Closure in Premature Neonates (후방 소개흉술을 통한 미숙아 동맥관 개존증의 수술요법)

  • Lee, Hyang-Lim;Choi, Chang-Hyu;Son, Dong-Woo;Shim, So-Yeon;Park, Kook-Yang;Park, Chul-Hyun
    • Journal of Chest Surgery
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    • v.42 no.4
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    • pp.434-440
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    • 2009
  • Background: Surgical closure of a patent ductus arteriosus (PDA) can be considered when conservative medical treatment is ineffective or contraindicated. Low weight and earlier gestational age neonates who are treated with conservative medical therapy generally showed a higher failure rate. The morbidity of surgical PDA closure in such extremely low birth weight (ELBW) neonates is also high. Here we present the early results of a new technique for approaching the PDA through a dorsal minithoracotomy. Material and Method: From March 2006 to November 2008, 24 premature neonates underwent surgical PDA closure. The procedures were performed in the newborn intensive care unit via a 2 cm long dorsal minithoracotomy with the baby in the prone position with the left hemithorax elevated 30$^{\circ}$. Bimanual cotton swab blunt dissection completed the extrapleural accesstothe PDA and then two clips were applied. Tube thoracostomy was avoided if there was no meaningful pleural laceration. Result: The infants mean gestational age was 26.5$\pm$2.1 weeks (range: 23 to 30 weeks) and the average age at operation was 11$\pm$11 days. The mean body weight at operation was 933$\pm$271 grams (range: 570 to 1,700 grams). Eight patients expired, but there was no procedure-related death. Postoperative echocardiography revealed two cases of residual shunt but none of these shunts were detected on the follow up echocardiogram that was performed on the post operative 5 and 59 days. Conclusion: We concluded that the technique described here is an effective procedure in view of the satisfactory operative exposure and the low rate of complications.

Role Formation by Interaction Function and Pattern for Group Discussion Activity using the case of Environmental Education Camp for Undergraduate Student (대학생 환경교육캠프 사례에서의 집단 토의 활동에 있어서 상호작용 기능과 양상에 따른 역할 형성 양상)

  • Jung, Won-Young;Lee, Go-Eun;Shin, Hyeon-Jeong;Cha, Hyun-Jung;Kim, Chan-Jong
    • Journal of The Korean Association For Science Education
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    • v.32 no.4
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    • pp.555-569
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    • 2012
  • Many science education research and practices are recently emphasizing the importance of collaborative learning. This study also understands learning in aspects of socio-cultural context, and regarded the creation of meaning in a same-age group as an important learning process. This is most especially true in the premise that the formation of roles in a collaborative learning is important for successful interactive learning. This study aims to find out how roles form in a group. For this purpose, university students participating in a group discussion activity about energy flow and circulation of material were selected as research participants. Discussions among the nine students in one group consisted of cognitive conversations on the topic and operational conversations for preparing a presentation. Video-clips of the discussions were made and transcribed. For the analysis, we developed a framework that includes four interaction functions (cognitive, organizational, meta-cognitive, operational), four action elements (question, simple answer, providing opinion, response to opinion), and two to four intention elements by each action elements. As a result, a total of nine roles were revealed through the interaction function and element; cognitive questioner, operational questioner, simple answerer, operational suggester, organizational commander, operational commander, cognitive explainer, terminator, reflective thinker. These roles are re-classified into seven utterance patterns by the utterance order and object, and they were categorized into three role groups (facilitating interaction, sustaining interaction, finishing interaction). The result means that role formation and function can have influence on learning and interaction. This study is meaningful to the suggestion to collaborative learning including project-based learning, investigation, club activity, and for the re-illumination of the role in an aspect of the interaction.

Exploration, Conflicts, Challenges, and Changes: A Teacher Educator's Self-Study for Secondary School Physics Instruction Course (탐색, 갈등, 도전, 그리고 변화 -물리교과교육 수업을 위한 한 교사교육자의 셀프스터디-)

  • Choi, Jaehyeok;Jo, Kwanghee;Joung, Yong Jae;Kim, Heekyong
    • Journal of The Korean Association For Science Education
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    • v.36 no.5
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    • pp.739-756
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    • 2016
  • The purpose of the study is to reflect on 'myself' as a teacher educator of college of education in depth and to improve my instruction through self-study with three critical collaborators. 17 pre-service science teachers and I have participated in this study of a teacher educator's course since March 2016 after the preliminary practice in 2015. The video recorded the course for 11 weeks with about 40 hours of lessons. The data source also included teacher educator's reflective journals, lecture evaluations, online boards and so on. Questionnaires were distributed and answered both at the beginning and at the end of the course and pre-service teachers wrote their reflective journals. Four of them were in the focus group interviews. During the course, the weekly group meeting of critical collaborators analyzed the emerging issues based on the lesson clips and teacher educator's reflective journals with discussion for the course innovation. Four phases were revealed in the process and for the purpose of the course such as exploration, conflicts, challenges, and changes. The results showed that first, we identified tensions among the teacher educator's multiple identities as a lecturer, a faculty member, and a researcher. Second, there were differences between goals of teacher educator and pre-service teachers in the course, and this obstructed the success of the course sometimes. Third, these practices led to explore balanced alternative views and interpretations of the problem by critical views and to expand and improve our teaching practice and thinking. In addition, the self-study with critical collaborators helped to bring conflicts and issues below my practice to light for collaborative reflection and it gave a chance to understand ourselves as teacher educators in different ways.

The development of Home Economics Education program for the prevention of school violence in middle school : Based on the Practical Action Teaching Model (학교폭력 예방을 위한 중학교 가정과 교육 프로그램 개발 - 실천적 행동 수업 모형을 적용하여 -)

  • Son, Joo Young;Chae, Jung-Hyun
    • Journal of Korean Home Economics Education Association
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    • v.25 no.2
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    • pp.103-128
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    • 2013
  • The purpose of this study was to develop a school violence prevention program featuring the Practical Action Teaching Model(hereafter, PATM) for middle school students to prevent school violence by Home Economics Education. To accomplish this purpose, the processes of analysis, design, development, and evaluation based on ADDIE were conducted. The validity of the program was evaluated twice by Home Economics education experts(36 experts for the first group and 10 experts for the second group) and the contents of the program were modified according to the comments from the evaluators. The school violence prevention program in Home Economics classes consisted of 5 topics such as changing perception on school violence, enhancing self-esteem, relating with others, practicing consideration and sharing, and strengthening the will of preventing school violence. Twenty-four units were developed with 7 practical problems(What should I do to make friends to help with each other?, What should I do to establish positive self-concept?, What should I do to communicate to build good relationship?, What should I do to solve the conflicts peacefully?, What should I do to practice consideration and sharing in food consumption?, and What should I do to practice consideration and sharing in clothing?) in 5 topic areas. Teaching-learning plans included four steps such as problem perception, practical reasoning, action, and evaluation that comprise PATM to solve the practical problems. Every step of the teaching-learning plan consisted of questions for practical reasoning and activity assignments. Materials for students and teachers were developed. Materials for students comprised 80 pieces in total including student activity, reading, movie, and clips to make students enhance understanding and interest. Materials for teachers comprised 35 pieces in total such as rationales, newspaper articles, and movies that make teachers that lesson teaching loads and were helpful for teachers. The PATM was incorporated into developing the program and a Likert-scale was used to assess usefulness, applicability, appropriateness, fidelity, substantiality, and validity of this program. This program gained more than 4.00 on a 1-5 Likert scale. This result indicated that program is expected to be effective and useful to school violence prevention.

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Giant Coronary Artery Aneurysm Presenting as a Calcified Mediastinal Mass a, Coronary Artery Fistula - A case report - (종격동 종양으로 오인된 거대관상동맥류와 관상동맥루 - 치험 1례 -)

  • Yoon, You-Sang;Lee, Cheol-Joo;Choi, Ho;Kang, Jun-Kyu;Choi, Jin-Wook;Kim, Hyung-Tae
    • Journal of Chest Surgery
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    • v.34 no.10
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    • pp.787-791
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    • 2001
  • Coronary artery aneurysm is a rare disorder. It is defined as abnormal dilatation of coronary artery with diameter exceeding 1.5 times the adjacent normal segments. The incidence of coronary aneurysm is 2.6% in Caucasians and 0.25% in Asians. Over half of the former were associated with atherosclerotic coronary artery disease. However, 70 percents of the latter were nonobstructive coronary artery aneurysms. Coronary artery fistula is a rare disorder. It has been identified in only 0.2% of routine cardiac angiographic studies conducted over a 10-year period. The clinical spectrums are various, asymtomatic, asymptomatic murmur, dyspnea on exertion, fatigue, and congestive heart failure. The right coronary artery (56%) and left coronary artery(36%) are mainly involved in the origin site of congenital coronary artery fistula. The draining site of fistula are right ventricle(39%), right atrium(33%), and pulmonary artery(20%) and so on. This 54 years-old woman had intermittent chest tightness and an abnormal mediastinal shadow on chest roentgenogram and chest C-T examination, which was diagnosed as a mediastinal mass such as teratoma. We performed the operation under left anterolateral thoracotomy for mass excision. However, we knew the mass had the pulsating arterial blood flow through a fine needle puncture of the mass and that it was attached to the left ventricle. We believed the excision of mass on beating heart would be very dangerous. Therefore, we closed the wound without excising the mass. After several days, we performed an echocardiography and coronary angiography, We knew it was cardiac tumor. Incidentally, the patient had a tortuous coronary fistula from the right coronary artery to pulmonary trunk. Using cardiopulmonary bypass with moderate systemic hypothermia, the mass was resected and the fistula was clipped with surgical clips. Pathology of the specimen was a giant coronary arterial aneurysm.

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The Changes of Smart Device Usage Status in Early Childhood: Comparison of 2015-2016 and 2017 Studies (유아 스마트 기기 사용 현황의 변화: 2015-2016년과 2017년의 연구 결과 비교)

  • So, Hyejin;Lim, Sungmin;Cho, Sang Yeun;Koh, Min Suk;Moon, Jin-Hwa
    • Journal of the Korean Child Neurology Society
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    • v.26 no.4
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    • pp.251-262
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    • 2018
  • Purpose: This study aimed to identify changes in smart device usage trends of young children using two studies conducted in 2015-2016 and 2017 respectively. Methods: We compared the data of the previous study of 130 children (Group A) and the new study of 162 children (Group B). The children and parents were recruited from kindergartens in Seoul and Guri/Namyangju cities. We used the "Parental questionnaire for smart device usage status." Results: There were some changes in the smart device usage in young children and parental perception. In the 2017 study, smart device usage time increased during weekends (P<0.05) and the usage with siblings decreased (P<0.05). In 2017, the smart device was mostly used when children had to be quiet without disturbing others (36.8%). No significant difference existed in the main purpose of use: watching video clips (79.3% vs 76.6%). Overall control of the usage was still largely exercised by mothers; however, when using applications, mothers still only helped the children on request (51.8% vs 49.7%). Regarding the effect of smart device on children, responses of "not knowing" decreased and "will be negative" and "will be positive" increased (P<0.05). Additionally, most mothers thought that "Although the smart device is currently unnecessary, it will be needed in future" in 2017 (46.3%). Conclusion: Limiting the smart device usage time during the weekends and increasing parental involvements are recommended. Guidelines for smart devices usage in young children are also necessary considering the changes in parental attitudes in recognizing the smart device usage as unavoidable.